Takotsubo Cardiomyopathy after Systemic Consolidation Therapy with High-Dose Intravenous Cytarabine in a Patient with Acute Myeloid Leukemia

Abstract

Background: Takotsubo cardiomyopathy (TC) is characterized by the abrupt onset of cardiac dysfunction, with transient apical and midventricular hypo-/akinesia with a compensatory hypercontractility of the remaining segments. The clinical presentation appears to be similar to acute myocardial infarction (AMI). However, the myocardial dysfunction is reversible. Case Report: We report on the case of a 58-year-old man with acute myeloid leukemia (AML) who was admitted to our hospital to receive the second course of consolidation chemotherapy with intravenous cytarabine. Subsequently, the patient developed severe dyspnea at rest, with cardiogenic shock after the central venous catheter was removed. Echocardiography revealed severe dyskinesia of the mid and apical portions of both ventricles, accompanied by a highly reduced left ventricular function (LVF). 5 months later, 12-lead electrocardiography (ECG) did not show any evidence of repolar-ization disorders and echocardiographic evaluation revealed a normal LVF. We suppose that the underlying mechanism was TC. Conclusions: TC can occur in patients with AML under systemic chemotherapy, which possibly represents a triggering factor for TC development. Cardiogenic shock is a serious life-threatening complication of TC. Nevertheless, the prognosis of TC is favorable and a complete recovery of the LVF is possible.

Reversible Cardiomyopathies

“…Additionally, there have been numerous reports linking this entity to certain medications and toxins such as albuterol, 69 high-dose intravenous cytarabin, 70 5-fluorouracil, 71 entacapone, 72 and allopurinol 73 as well as the inhalation of hypochlorite gel exhalations. 74 Furthermore, a case has been reported on a possible link to cocaine abuse.…”

Acute Heart Failure in a Patient with Acute Myeloid Leukemia following Daunorubicin Treatment: a Case Report

“…Rarely, takotsubo cardiomyopathy has been associated with use of these agents [10,11], however in the presented case the resolution of the heart failure occurred over the course of months. The occurrence of acute anthracycline induced heart failure following a very high dose density of daunorubicin (405 mg/m 2 within a 3 week period) raises the important issue of whether this high dosage within a short time interval might increase the risks for the development of anthracycline cardiotoxicity.…”

Mechanisms of Cardiovascular Damage Induced by Traditional Chemotherapy

“…Beside typical scenarios of ACS, oncologic patients can also undergo apical ballooning syndrome, precipitated by several factors, among which is the exposure to various and significant stressors [99]. In particular, this syndrome has been noted in patients treated with 5-FU, capecitabine, cytarabine, axitinib, sunitinib, bevacizumab, rituximab, trastuzumab, and combretastatin [100][101][102][103][104][105][106][107][108][109]. In 38 subjects with cancer and stress cardiomyopathy seen at the MD Anderson Cancer Center, female sex (76%), advanced age (65.9 ± 9 years), and advanced cancer were the main patient characteristics [110].…”